In the COVID-19 response, some sites are challenged when it comes to offering and vaccinating significant numbers of refugee, immigrant, and migrant (RIM) community members at mainstream vaccination sites due to transportation barriers, language access issues, and challenges regarding stigma. This challenge exists for both administering the COVID-19 vaccine and routine vaccinations, especially in the pediatric population. Ensuring equitable barrier-free access to vaccines and accurate health information is especially critical for RIM communities to mitigate the disproportionate impacts of COVID-19.
Bringing Vaccines to RIM Communities
Health departments and community-based organizations (CBOs) are implementing innovative solutions to getting vaccines to their populations. Mobile vaccine units are proving to be a successful solution for ensuring COVID-19 vaccines reach RIM populations. These mobile units are also providing standard vaccine services to pediatric populations that have not been in for their routine wellness checks.
When utilizing existing or creating mobile vaccine units, consider:
- Coordinate with Department of Transportation for access to transit vehicles.
- Partner with health insurance companies to provide medical staffing for mobile units.
- Utilize community health workers and promoters to knock on doors, leave flyers, and explain when the mobile vaccination unit will come to their area the week before setting up vaccine clinics.
- Reach out to CBOs in the local area to share information about mobile vaccination units' location, dates, and times, or having the CBO’s host the mobile unit on their site.
- Have bilingual community members integrated into the staffing to ensure people are from and recognized by the community, easing language and culture barriers.
- Staff the mobile vaccination units with interpretation services and education materials to:
- Answer community members' questions
- Encourage prevention behaviors including physical distancing, mask-wearing, hand washing, cleaning and disinfecting, and avoiding close contact if someone is sick, including household members
- Ensure health education materials are appropriately explained with interpretation services and translated into appropriate languages
- Facilitate vaccination process
Modifying City Buses in to Vaccinate Communities
The Minnesota Department of Health (MDH) partnered with the MN Department of Transportation (MnDOT) and Blue Cross Blue Shield (BCBS) to outfit public transit buses to deliver vaccines to vulnerable communities. The buses can vaccinate 100 - 150 people per day as they hold two waiting clients while vaccinating two clients. Community members can register on-site at a pop-up tent, streamlining the process. The MDH uses zip codes and federal data to identify vulnerable areas and sets up at community centers and apartment complexes. The team also focuses on agricultural workplaces, homeless encampments, and housing complexes where residents lack transportation. The vaccines are free; IDs, proof of citizenship, and insurance are not required, and the buses are ADA accessible. So far, MDH and BCBS have modified two buses but plan on adding four more buses over the next few months. Community partners can request a visit from the mobile unit via the MDH website.
- MDH: COVID-19 Community Mobile Vaccination Bus Project
- Minnesota to send 40% of COVID-19 vaccine doses to hard-hit communities
- Minnesota deploys modified buses for mobile vaccination clinics
New York City and Restaurants Organization Advocating Rebuilding (ROAR) have partnered to vaccinate restaurant workers and delivery workers, many of whom are members of the RIM community, via 20 modified transit buses. The ADA accessible buses have a registration area and six vaccination rooms, plus a refrigerator to store the Johnson & Johnson and Moderna vaccines. They are being staffed by workers who speak English, Spanish, Mandarin, and Cantonese.
- New York City Mobile Vaccine Buses
- Restaurants Organization Advocating Rebuilding (ROAR)
- New York City Mobile Vaccine Bus Video
The Tufts Health Plan and Harvard Pilgrim Health Care partnered to launch the Mobile Vax van to vaccinate vulnerable neighborhoods and communities against COVID-19. The Mobile Vax van leveraged The Latino Equity Fund and East Boston Neighborhood Health Center’s community connections to offer vaccine access, overcome vaccine hesitancy, and accelerate vaccine distribution. Mobile vaccination clinics can administer up to 500 vaccines per day. The group works with a multi-cultural marketing agency and minority-owned businesses to spread community awareness and provide COVID-19 vaccine registration information.
- Mobile COVID-19 Vaccination Buses Visit Local Communities to Reach Underserved Communities
- Mobile COVID-19 Vaccination Buses to Visit Local Communities
Bringing Vaccines to the RIM Community in Pennsylvania
Lancaster Health Center, a federally qualified health center (FQHC) in Lancaster, PA, collaborated with the Lancaster City Housing Authority to conduct testing in high-density housing locations. Since Lancaster does not have a local health department, the FQHC reached out to their state health department to use their Community-Accessible Testing and Education (CATE) van and offer testing at sites where the community may have limited transportation. During testing, the FQHC created medical record numbers for the community members to aid in follow-up contact tracing and case investigation. The CATE van can also be used for community vaccination.
Bringing Vaccines to the RIM Community in Colorado
Denver Health deployed a Mobile Health Center (MHC) on November 13, 2020, to conduct curbside COVID-19 testing for people who might not otherwise have access to testing. People can drive, walk, or bike through to get tested. Testing is available by appointment or by same-day walk-up. They stationed the MHC in a RIM neighborhood for the first two months. Then in January, they began partnering with community-based organizations (CBOs) like churches and food banks to bring curbside testing to neighborhoods in the community that had higher positivity rates and less access to testing sites. As of February 5th, they continue to partner with CBOs and are transitioning to offer vaccination outreach events with the Mobile Health Center. The MHC is a bright, convenient, and welcoming environment offering an alternative to people who might have barriers to getting care through traditional health care options. “In our 54 days of operating, we have conducted 1,230 COVID-19 tests and ninety-one COVID-19 vaccinations” exclaims a nurse practitioner with the MHC
Reaching the RIM Community in Minnesota
During COVID-19 restrictions, to address the declining rates of childhood immunizations, Hennepin Healthcare Department of Pediatrics and Community Paramedics partnered together to create the Vaccine Mobile Program. Rather than replacing a medical home, the mobile vaccine unit seeks to reduce healthcare barriers and provide childhood immunizations to families who are reluctant or unable to be seen in a traditional healthcare setting. The unit is staffed with a paramedic and pediatric nurse practitioner. The team provides a brief health exam, administers vaccines, screens for food insecurities, lead and asthma, and provides referrals to social services as needed. Sheyanga Beecher, a pediatric nurse practitioner from the program, says, "The results are promising. Not only are families very appreciative of this service, but we are also making gains to maintain childhood vaccination rates despite the pandemic." They hope to use this mobile unit to distribute COVID-19 vaccines to the community.
Reaching the RIM Community in Washington
When COVID-19 affected the migrant worker community in Washington, Columbia County Public Health reached out to Columbia Valley Community Health, who formed a mobile outreach team comprised of medical assistants, a nurse, and a provider to offer testing and education in migrant work camps. The partnership allows public health to communicate COVID-19 responses between the health department the clinic so the outreach team can mobilize quickly and go on-site with their mobile clinic for testing or CICT. Since the members of this team are from the FQHC, they are familiar with the community and have the trust of their clients.
Reaching the RIM Community with Emergency Medical Services (EMS) in Washington
Emergency Medical Services (EMS) run by Lake Chelan Health in the Lake Chelan Valley of WA has a history of leading community outreach for their rural community, including mobile influenza vaccine units with their ambulances. When the opportunity came to start vaccinating their community for COVID-19, they partnered with local agricultural businesses to bring ambulances and paramedics to deliver vaccines and do post-vaccination monitoring at their businesses. The vaccination outreach also included H2A visa-holders. The majority of the employees preferred to speak Spanish and Lake Chelan EMS brought interpreters to the mobile vaccine sites, and they also had an on-call American Sign Language interpreter available. They have also brought their mobile vaccine unit to local apartment complexes and went door-to-door offering vaccination.